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目的探讨急性脑梗死患者出血转化(HT)的危险因素。方法收集2013年6月至2016年9月于该院住院治疗且资料完整的急性脑梗死患者335例,其中HT组47例,非HT组(NHT组)288例。收集并比较两组患者一般临床情况、实验室检查指标、影像学特点及治疗措施的差异,应用Logistic回归分析筛选急性脑梗死患者HT的危险因素。结果单因素分析显示,两组患者在糖尿病史、心房颤动病史、神经功能评分(NHISS评分)、入院收缩压、空腹血糖、糖化血红蛋白、低密度脂蛋白胆固醇、纤维蛋白原、梗死部位、大面积梗死及溶栓治疗等方面差异有统计学意义(P<0.05)。Logistic回归分析显示,心房颤动病史(OR=2.703,95%CI1.169~6.250)、高空腹血糖(OR=2.098,95%CI 1.532~2.875)、大面积脑梗死(OR=9.999,95%CI4.648~21.510)及溶栓治疗(OR=6.557,95%CI1.954~22.003)是HT的独立危险因素。结论心房颤动病史、高空腹血糖、大面积脑梗死及溶栓治疗是发生脑梗死后出血转化的危险因素,需安排相应的护理措施以利于疾病治疗。
Objective To investigate the risk factors of hemorrhagic transformation (HT) in patients with acute cerebral infarction. Methods A total of 335 patients with acute cerebral infarction were enrolled in the hospital from June 2013 to September 2016, including 47 HT patients and 288 non-HT patients (NHT group). Collecting and comparing the general clinical conditions, laboratory tests, imaging features and treatment measures of two groups of patients, using Logistic regression analysis to screen the risk factors of HT in patients with acute cerebral infarction. Results Univariate analysis showed that there was no significant difference between the two groups in the history of diabetes, the history of atrial fibrillation, the score of neurological function (NHISS), admission systolic pressure, fasting blood glucose, glycosylated hemoglobin, low density lipoprotein cholesterol, fibrinogen, infarct size, Infarction and thrombolysis and other aspects of difference was statistically significant (P <0.05). Logistic regression analysis showed that the incidence of atrial fibrillation (OR = 2.703, 95% CI1.169-6.250), high fasting blood glucose (OR = 2.098,95% CI 1.532-2.875), large area cerebral infarction (OR = 9.999,95% CI4 .648 ~ 21.510) and thrombolytic therapy (OR = 6.557,95% CI1.954 ~ 22.003) were independent risk factors for HT. Conclusion The history of atrial fibrillation, high fasting blood glucose, large area cerebral infarction and thrombolytic therapy are the risk factors of hemorrhage and conversion after cerebral infarction. Corresponding nursing measures should be arranged to facilitate the treatment of the disease.